Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study

Objective Evaluate the association between gout and riskof advanced chronic kidney disease (CKD).Design Retrospective matched cohort study.Setting UK Clinical Practice Research Datalink.Participants The analysis included data for 68 897patients with gout and 554 964 matched patients withoutgout. Patients were aged ≥18 years, registered at UKpractices, had ≥12 months of clinical data and haddata linked with Hospital Episode Statistics. Patientswere excluded for history of advanced CKD, juvenilegout, cancer, HIV, tumour lysis syndrome, Lesch-Nyhansyndrome or familial Mediterranean fever.Primary and secondary outcome measures AdvancedCKD was defined as first occurrence of: (1) dialysis, kidneytransplant, diagnosis of end-stage kidney disease (ESKD)or stage 5 CKD (diagnostic codes in Read system orInternational Classification of Diseases, Tenth Revision);(2) estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m²; (3) doubling of serum creatinine frombaseline and (4) death associated with CKD. Results Advanced CKD incidence was higher for patientswith gout (8.54 per 1000 patient years; 95% CI 8.26 to 8.83) versus without gout (4.08; 95% CI 4.00 to 4.16). Gout was associated with higher advanced CKD riskin both unadjusted analysis (HR, 2.00; 95% CI 1.92 to 2.07) and after adjustment (HR, 1.29; 95% CI 1.23 to1.35). Association was strongest for ESKD (HR, 2.13; 95% CI 1.73 to 2.61) and was present for eGFR <10 mL/ min/1.73 m² (HR, 1.45; 95% CI 1.30 to 1.61) and serum creatinine doubling (HR, 1.13; 95% CI 1.08 to 1.19) but not CKD-associated death (HR, 1.14; 95% CI 0.99 to 1.31). Association of gout with advanced CKD was replicated in propensity-score matched analysis (HR, 1.23; 95% CI 1.17 to 1.29) and analysis limited to patients with incident gout (HR, 1.28; 95% CI 1.22 to 1.35). Conclusions Gout is associated with elevated risk of CKD progression. Future studies should investigate whether controlling gout is protective and reduces CKD risk.